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General NPI Number Information
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NPI Number | 1457189698
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Entity Type | Organization
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Legal Business Name | LEMON TREE REHABILITATIVE SERVICES LLC
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 850 INDIGO ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3763
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Country | US
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Telephone | 904-704-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 200 RIVER OAKS DR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-9278
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Country | US
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Telephone | 904-704-5565
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE DESILET
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Credential |
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Telephone | 904-704-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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